Erectile Dysfunction drugs such as Viagra, Cialis, and Levitra have made huge strides in treating male sexual dysfunction — but have women been left behind? At this writing (September 2009), no treatment has been approved by the FDA for Female Sexual Dysfunctions (FSD), which are estimated by the Journal of the American Medical Association to affect 43% of American women (about 40 million) at some point in their lives.

It’s not for lack of trying. Pharmaceutical makers would love to tap into a market that’s the other 50% of the population. They are assertively researching the problem. So why has a result not come forward?

One issue is that, with men, “sexual dysfunction,” no matter whether the cause is mental or physical, is likely to respond as a pretty straightforward plumbing problem: Viagra and its counterparts, the Phosphodiesterase Type 5 Inhibitors, are vasodilators, meaning that they open up blood flow to the area, allowing an erection to be achieved and retained more easily. (More information on the effects of these vasodilators on women is below.)

But women’s sexuality is more complex and less understood, often caused by a range of physical, emotional, and psychological conditions. Simple manipulation of bloodflow only goes so far. Another element is that women have unique hormone issues, which often cause low libido, as they age. Finally, some researchers are experimenting with methods that place sexuality in the mind.

The good news is that research IS progressing. Here’s an update on where the various methods are:

THE BIG THREE (Viagra, Cialis, Levitra)

Researchers are looking into using male ED drugs on women suffering from FSD. In April of this year, a study by the American Physiological Society was described that compared the effects of three drugs used for erectile dysfunction (Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil)) on female rats. The researchers discovered that these drugs significantly increased blood flow to female sexual organs, and show promise for treating similar conditions in human women. Another study has shown that Viagra can help with orgasms in women who are taking SSRIs and suffering sexual dysfunction as a side effect.

There is promise here, but it is all forward-looking. The FDA has not approved these medications for use by women. We will be closely following the progress of this research.

HORMONAL TREATMENTS

The hormone testosterone drives sexual desire, and as women age, they typically lose some of both. There are some doctors that prescribe testosterone off-label to women to help with low desire, but this process is not approved by the FDA. There have been flops along the way to a hormonal treatment. Intrinsa, a testosterone patch for women, was turned down by the FDA in 2004 due to worries about long-term safety, and PT-141 was a nasal spray that was being tested to raise desire in both men and women when it was quashed by the FDA for having possible blood-pressure-related side effects.

In upcoming news, though, BioSante Pharmaceuticals of Illinois is in late-stage studies of a testosterone gel intended to remedy libido loss after menopause. The product, called LibiGel, is smeared on the upper arm and promotes a long, slow build-up of testosterone in women. We’ll be eagerly watching to see if LibiGel is approved by the FDA.

NEUROTRANSMITTER ADJUSTMENTS

A nonhormonal treatment for FSD is in late-stage testing. Boehringer Ingelheim’s Flibanserin, a pill to be taken daily, acts on serotonin receptors in the brain. Early reports suggest that the medication was not useful for treating depression (its intended use), but had the curious side effect of increasing desire in females. The company is now researching the drug’s effects directly in younger, premenopausal women who are suffering from low desire.

The reality is that there is no approved pharmaceutical treatment on the market for a condition that troubles millions of women. The good news is that there are a few promising treatments on the horizon, and we encourage women to follow issues like this in the news so that they will know when relief becomes available. Some of the companies mentioned in this article are conducting clinical trials of these medications, so if you are deeply interested and want to participate, that is a possibility, too. We should see some major changes in the field in the next few years.

Millions of dollars in direct-to-consumer advertising by big pharmaceutical companies have ensured that most Americans are familiar with the “Little Blue Pill” — Viagra — as well as with competing products Cialis and Levitra. These drugs, called phosphodiesterase inhibitors, enhance the effects of nitric oxide, a chemical that relaxes muscles in the penis. This increases blood flow to enable an erection to occur with proper stimulation.

There are differences among the three medications, but they are relatively minor. Viagra came on the scene first, so it’s helped more people and has a longer track record. Levitra begins working the fastest, and Cialis lasts the longest — up to 36 hours, compared to four for Viagra.

Often, a doctor might prescribe one of these three pills for you, and if you don’t respond, they will switch you to another. But what happens if Viagra, Cialis and Levitra all fail for you? Or what if you have one of the conditions that don’t allow you to take ED pills — such as heart problems, high blood pressure or diabetes?

There’s actually an effective alternative that relatively few people know about — because it’s been scarcely advertised. It’s called alprostadil, which can be sold as Caverject, Edex or Muse. Alprostadil is a synthetic version of prostaglandin E, a hormone. Like the better-known pills, it relaxes muscle tissue in the penis to enhance blood flow. It even works faster than the pills — in as little as five minutes.

The downside to alprostadil, relative to the oral treatments, is how it’s administered: by needle or suppository. The needle-injection therapies, Caverject or Edex, are generally preferable, because it is a very fine needle and there is little or no pain. It’s also easy to administer yourself.

The suppository treatment (Muse) requires inserting a dosage of alprostadil, about half the size of a grain of rice, into the tip of your penis. Administering Muse can be a little painful.

If you’ve been getting your ED information only from watching TV commercials, we hope we’ve shed light on some options you might not have known about. One of the things I’ve feared, with all the attention devoted to Viagra and Cialis, is that men with ED will downplay their histories of heart disease or other risk factors in order to get their doctor to write a prescription for them. I’m sure this has happened thousands of times, unfortunately.

Now you know you don’t have to take that kind of risk. Ask your doctor about alprostadil as an alternative to the Little Blue Pill.

As you know, we like to post links to parodies of pharmaceutical commercials. Rather than publish these individually, though, I thought I’d provide all these links in a single roundup post. Here are some popular parodies of current drug ads — one for each drug. (Be warned that some of them are a little off-color.) Enjoy!

• Zoloft
• Viagra
• Cialis
• Mirapex (restless leg syndrome)
• Lipitor
• Valtrex

Here are the top 25 searches on eDrugSearch.com for the month of March, including searches for both medications and medical conditions, starting with the most popular search. eDrugSearch.com visitors have conducted more than five million searches since our launch in January 2007.

1. Viagra
2. Vytorin
3. Provigil
4. Cialis
5. Synvisc
6. Fosamax
7. Finasteride
8. Amoxicillin
9. Lotrel
10. Wellbutrin
11. Lipitor
12. Lyrica
13. Naproxen
14. Singulair
15. Loestrin
16. Valtrex
17. Yasmin
18. Ibuprofen
19. Quetiapine
20. Allegra-D
21. Lamisil
22. Alendronate
23. Plavix
24. Bactrim
25. Nardil

Sprint’s Super Bowl commercial that parodies Big Pharma’s male-impotence advertising is hilarious.

(Via NFL-Scores.)

From John Whiteside of the Houston Chronicle’s Blue Bayou blog:

The Lunesta moth! Running through fields of flowers! The purple pill! The couple that loves the, er, flexibility of Cialis! Television today is a pharmaceutical wonderland … As I watch those ads, I wonder, is this really a good idea?…

These are all good drugs that help people. But they are also drugs whose use is not considered simple enough for them to on the shelf at your local CVS. If a doctor’s advice is needed to take them, why are they being advertised? I thought the idea was that you went to your doctor and said, “I have ____,” and she or he said, “OK, here’s what I recommend…”

Well, we all know why they are being advertised; for the same reason that toys are advertised to children too young to have actual money to buy things themselves. If people are going to the doctor saying, “I want Cialis!” there will be more prescriptions for it…

And how about the bill for all this? $1.9 billion is a lot of money. In the context of discussion of health care costs, it’s an interesting thing to think about.

Amen, brother.